Medical field expected to run short on primary-care doctors

Sunday

Mar 1, 2009 at 12:01 AMMar 1, 2009 at 12:22 AM

Medical officials nationwide are encouraged by the recent boost in federal money to train primary-care doctors, a move aimed at staving off a deepening shortage in the field. President Barack Obama’s stimulus package and federal budget proposal include money to help convince medical students to become primary-care doctors.

Melissa Westphal

Medical officials nationwide are encouraged by the recent boost in federal money to train primary-care doctors, a move aimed at staving off a deepening shortage in the field.

President Barack Obama’s stimulus package and federal budget proposal include money to help convince medical students to become primary-care doctors.

“The Obama administration really gets it in terms of what’s wrong,” says Dr. Ted Epperly, president of the American Academy of Family Physicians and program director of family residency in Idaho. “We have this dearth, this absence, of primary-care physicians. It’s not good to be top-heavy with specialists if people can’t get access to primary care.”

A 2006 report by the AAFP predicted a need for nearly 140,000 family physicians by 2020. That will require graduating about 4,500 physicians from accredited residencies; at the current rate, the medical education system will graduate fewer than half of that total.

Pair that with decades of declining student interest, and the problem only gets worse.

Supplying the local pool

Some communities, however, seem more prepared for the crunch because medical officials have made primary-care training a priority.

“Our community is better positioned now and in the future because I think we’ve done a good job in terms of the pipeline,” says Martin Lipsky, dean of the University of Illinois College of Medicine at Rockford.

The college graduates 50 students a year, and half of them go into primary care: family physicians, internists, obstetricians/gynecologists, pediatricians and general practitioners.

Of the 150 College of Medicine graduates still practicing in Illinois, about 80 work within 50 miles of Rockford, Lipsky says. In fact, the college’s Family Practice Residency training program has trained more family physicians than any other program in Illinois.

But catching up to the primary-care demand is still a challenge.

The population is growing faster and aging faster than doctors and medical schools can keep up with. Doctors are retiring earlier than they used to, and geography and gender play a part, too.

Footing the bill

It’s also very expensive to educate a medical student — about $90,000 a year -- because schools are paying board-certified doctors and surgeons to teach, and the medical teaching equipment is expensive.

State and federal funding only go so far to pay for those spots, which leaves hospitals and medical schools struggling to pick up the slack.

Chantal Girod graduated from the Rockford residency program. She works as a family-medicine doctor through SwedishAmerican Medical Group. Her husband, Dr. Bruce Stiles, works at the same clinic.

Girod toyed with joining obstetrics/gynecology, but high malpractice-insurance rates brought her back to primary care.

“I really enjoy the profession I chose,” Girod says. “I get to know people and their families and become a partner with them for whatever medical concerns they have. I love what I do.”

Girod was discouraged in college from becoming a primary-care doctor, mostly because it would pay less than a more specialized field. Epperly tells the same story.

Both say good mentors and a strong desire to work with people kept them in family medicine.

“No other type of specialty allows you to see people and track them over time, across all age groups,” Epperly says. “You’re really able to develop trusting relationships. At the end of the day, it’s not about money. It’s knowing you make differences in people’s lives.”

Patient-physician trust

A long-term relationship with a patient is undervalued in health care, Girod says, sharing her frustration that spending 30 minutes coordinating medications with patients to avoid complications is not reimbursed the same way a surgical procedure is.

“Working with patients this much helps you develop a trust. Knowing that well translates into better outcomes.”

Dr. Mike Chmell, an orthopedic surgeon with Rockford Orthopedic Associates, says few of his colleagues at the University of Chicago planned to go into family medicine, opting instead for surgery or such specialties as cardiology or oncology.

Epperly concurs, saying students are being pushed toward specialties to pay off their medical school debt faster.